Difficulty: Intermediate | Prerequisites: Chapter 9-10 notes; basic understanding of coping and adjustment in psychology.
These two chapters move from living with chronic illness to facing death. Chapter 11 covers how patients adjust to chronic disease across multiple life domains (cognitive, emotional, physical, behavioural, interpersonal) and what determines whether that adjustment goes well or poorly. Chapter 12 shifts to mortality: death at different life stages, the psychology of dying, stage theories of grief, and how survivors cope with bereavement. Together they cover the full arc from diagnosis to end of life. If you missed earlier material on stress, coping and social support, review those before diving in.
Chronic illness adjustment depends on SES, race, gender, personality and social support, and plays out across cognitive, emotional, physical, behavioural and interpersonal domains. Death statistics vary by age group: SIDS is the leading cause of infant death, firearms lead for children and adolescents. The Kubler-Ross model (denial, anger, bargaining, depression, acceptance) describes stages of grief, though the Dual Process Model offers a more flexible framework for bereavement.
Quality of Life
A measure of how biopsychosocial factors affect a person's overall wellbeing. Studying it helps us understand the full impact of chronic illness beyond medical symptoms.
Infant Mortality
The number of deaths in the first year of life per 1,000 live births.
Neonatal Mortality
The rate of death within the first month of life.
SIDS (Sudden Infant Death Syndrome)
A condition where infants stop breathing and die suddenly without an apparent cause, usually during the night. The highest cause of infant death in the U.S. Peak risk is at 2 to 4 months.
Slow Death
A predictable, drawn-out dying process. Difficult for loved ones and may compromise typical family relationship development.
Sudden Death
Unexpected death. Survivors may lack estate plans and may not achieve relationship closure.
Kubler-Ross Model
Five stages of grief: denial, anger, bargaining, depression, acceptance. Originally about the experience of dying, but transferable to experiencing loss generally.
Grief
The pain or mourning felt after a loss.
Bereavement
The state of grieving or mourning the death of a loved one.
Dual Process Model (DPM)
Proposes that bereaved individuals adapt best when they flexibly oscillate between loss-oriented coping (processing the loss) and restoration-oriented coping (adjusting to life changes). In simple terms, healthy grieving involves moving back and forth between confronting the loss and rebuilding daily life.
Studying quality of life matters because it allows us to understand how biopsychosocial factors affect life beyond just the medical diagnosis.
Addington-Hall & Kalra (2002):
Nurses tend to overestimate patients' anxiety, depression and distress.
When patient health is poor, patients noted more concern about family than about their own health.
Adjusting to chronic disease (Stanton et al., 2007) across five life domains:
Interpersonal – Maintaining or improving relationships, including with providers.
Cognitive – Enhancing self-esteem, preserving a sense of mastery.
Emotional – Regulating distress, maintaining personal worth, searching for meaning.
Physical – Recovering bodily functions, maintaining employment, mobility.
Behavioural – Managing pain and symptoms, negotiating the environment, maintaining routine activities.
Adjustment over time depends on disease severity, the speed of health decline, whether the condition is symptomatic or asymptomatic, and the specific diagnosis.
Adjustment across individuals: Even among similar clinical populations, adjustment varies. Large-scale prospective studies can compare pre- and post-adjustment.
Several factors predict how well a patient adjusts to chronic illness:
SES (socioeconomic status)
Race/ethnicity
Sex/gender
Social resources and support
Personality
Cognitive determinants (Hoyt & Stanton, 2018):
Primary appraisal predicts adjustment. This is the patient's initial assessment of whether the situation is a threat, a challenge or irrelevant.
Secondary appraisal predicts both adjustment and coping strategies. This is the patient's assessment of what they can do about it.
What psychotherapists should consider when providing psychological interventions alongside pharmacological treatment:
Psychological issues may be episodic, not constant.
Collaborate with the physician and the patient's family.
Understand the diagnosis and treatment options.
The specific therapy modality may not matter as much as the therapeutic relationship.
Use evidence-based approaches, particularly CBT.
Medication may include anti-anxiety drugs or antidepressants.
Support groups (from the textbook):
Internet and in-person support groups can provide valuable social support.
Caveat: information shared in support groups can be misinformation.
Infant mortality:
Defined as deaths in the first year of life per 1,000 live births.
Higher in southern U.S. states.
Highest among African Americans and American Indians (likely linked to socioeconomic factors).
Neonatal mortality: death within the first month of life.
SIDS (Sudden Infant Death Syndrome):
Infants stop breathing and die suddenly, usually at night, without apparent cause.
Leading cause of infant death in the U.S.
Highest risk at 2 to 4 months of age.
Protective factors: sleeping on back, fans in the room, breastfeeding, pacifier use.
Leading causes of death for children and adolescents (ranked):
Firearms
Motor accidents
Poisoning or overdose
Cancers
Suffocation
Middle age is defined as 35 to 64 (halfway between childhood and old age).
Two patterns of death:
Slow death – Predictable. Difficult for loved ones and may compromise family relationship development.
Sudden death – Unexpected. Survivors may not have estate plans and may miss relationship closure.
Life expectancy: Adjusting lifestyle can add roughly 10 years to life expectancy.
Psychological issues in advancing illness:
Much of Western culture centres on prolonging and controlling life. Key psychological issues include changes to self-concept, cultural factors, talking about death and adjustment.
Psychological adjustment to dying is fuelled by beliefs about what will happen after death.
Right-to-die and death with dignity: Concepts related to an individual's autonomy in making end-of-life decisions, particularly when facing terminal illness or debilitating conditions.
Stage theories describe the experience of dying but are also transferable to experiencing loss more broadly.
The Kubler-Ross model lists five stages of grief:
Denial
Anger
Bargaining
Depression
Acceptance
These stages do not necessarily occur in order and not everyone experiences all of them. The model is a framework, not a rigid sequence.
Grief is the pain or mourning felt after a loss.
Funeral is a ritual ceremony preceding the burial or other disposition of a body after death.
Bereavement is the state of grieving or mourning the death of a loved one.
The Dual Process Model (DPM) of coping with bereavement:
Proposes that bereaved individuals adapt best when they flexibly oscillate between two modes:
Loss-oriented coping – Processing the loss itself, confronting grief.
Restoration-oriented coping – Adjusting to life changes, taking on new roles, building new routines.
The DPM is considered a more realistic framework than the Kubler-Ross model because it accounts for the back-and-forth nature of grief rather than implying a linear progression.
Students often treat the Kubler-Ross stages as a fixed, linear sequence. They are not. People may skip stages, revisit them or experience them in a different order.
Students sometimes confuse grief with bereavement. Grief is the emotional experience of pain after a loss. Bereavement is the broader state of mourning.
Students may assume all chronic illness adjustment is the same. Even within similar clinical populations, adjustment differs based on personality, social support, SES and other factors.
Students sometimes think SIDS risk is constant throughout infancy. Peak risk is specifically at 2 to 4 months.
Know the five life domains of adjustment (Stanton et al., 2007) and be able to give an example for each.
Know the determinants of adjustment: SES, race/ethnicity, sex/gender, social support, personality.
Know Hoyt & Stanton (2018): primary appraisal predicts adjustment; secondary appraisal predicts adjustment and coping.
Memorise the ranked causes of death for children and adolescents (firearms, motor accidents, poisoning/overdose, cancers, suffocation).
Know SIDS details: leading cause of infant death, peak risk 2-4 months, protective factors.
Be able to list and explain all five Kubler-Ross stages.
Know the Dual Process Model and how it differs from the Kubler-Ross model.
Know the difference between slow death (predictable) and sudden death (unexpected).
Fill in the blank: SIDS risk is highest at ________ months of age. (2 to 4.)
True or False: The Kubler-Ross stages must occur in a fixed order. (False.)
Fill in the blank: The leading cause of death for children and adolescents in the U.S. is ________. (Firearms.)
True or False: In the Dual Process Model, healthy grieving involves staying focused only on the loss. (False – it involves oscillating between loss-oriented and restoration-oriented coping.)
Fill in the blank: Stanton et al. (2007) identified five life domains of adjustment: interpersonal, cognitive, emotional, physical and ________. (Behavioural.)
Q: Name the five life domains of adjustment to chronic disease (Stanton et al., 2007) and give a brief example of each.
A: Interpersonal (maintaining relationships with providers), cognitive (preserving self-esteem and mastery), emotional (regulating distress and finding meaning), physical (recovering bodily functions and maintaining employment), behavioural (managing symptoms and maintaining routines).
Q: What does the Dual Process Model propose about healthy bereavement?
A: It proposes that bereaved individuals adapt best when they flexibly move between loss-oriented coping (confronting the grief) and restoration-oriented coping (adjusting to new roles and routines), rather than staying fixed in one mode.
Q: List the top five causes of death for children and adolescents in the U.S. in ranked order.
A: 1. Firearms, 2. Motor accidents, 3. Poisoning or overdose, 4. Cancers, 5. Suffocation.
Q: How do primary and secondary appraisal differ in predicting adjustment to chronic illness (Hoyt & Stanton, 2018)?
A: Primary appraisal (assessing whether the situation is a threat or challenge) predicts adjustment. Secondary appraisal (assessing what can be done about it) predicts both adjustment and which coping strategies the patient uses.
The adjustment domains in Chapter 11 connect to the pain management material in Chapter 10, particularly how behavioural adjustment includes managing chronic pain. The grief and bereavement material in Chapter 12 links to stress and coping frameworks covered earlier in the course. The infant mortality and SIDS content connects to broader public health and epidemiology. The determinants of adjustment (SES, race, social support) reappear in Chapter 13's discussion of heart disease and diabetes.
Chronic illness, quality of life, biopsychosocial, adjustment to disease, Stanton 2007, Addington-Hall Kalra 2002, Hoyt Stanton 2018, primary appraisal, secondary appraisal, SES, social support, infant mortality, neonatal mortality, SIDS, sudden infant death syndrome, causes of death children adolescents, firearms, middle age, slow death, sudden death, right to die, death with dignity, Kubler-Ross, five stages of grief, denial anger bargaining depression acceptance, grief, bereavement, funeral, Dual Process Model, DPM, loss-oriented coping, restoration-oriented coping, CBT, support groups, PSY 320, health psychology, Michigan State University